Proarrhythmic Effect of Pacemaker Stimulation in Patients With Implanted Cardioverter-Defibrillators

Abstract

Background-We sought to determine the potential of right ventricular VVI backup pacing to induce ventricular tachyarrhythmias in patients with implanted cardioverter-defibrillators. Methods and Results-All consecutive patients presenting exclusively with pacemaker-induced tachycardias (PITs) were included in a prospective study using a crossover protocol. Patients were randomized to either group 1 (augmentation of the baseline frequency of the pacemaker to 60 bpm) or group 2 (pacemaker turned off) and were followed up for 1 year and then crossed over to the other programming, looking for reoccurrence of PIT. Of 150 consecutive patients, 39 (26%) had PIT, 13 of them exclusively (8.6%). Forty of 1063 analyzed tachyarrhythmias of all the patients were PIT (3%). Before inclusion in the study, the patients had 2.7Ϯ0.9 PITs in 11Ϯ6.5 months with their pacemakers programmed empirically at 42.3 bpm. During the study phase, no PIT occurred while the pacemaker was turned off, whereas programming to 60 bpm led to the recurrence of PIT in 5 of 6 patients (1.4Ϯ0.6 per patient). At the end of the study, 9 patients underwent a prolonged follow-up with their pacemakers turned off, resulting in spontaneous episodes of ventricular tachycardia/fibrillation in 5 patients, but PITs were no longer observed. Conclusions-This crossover protocol proves the potential proarrhythmic effect of pacemaker stimulation in implantable cardioverter-defibrillator patients. Resulting PITs led to clinical symptoms and antitachycardia therapy by the implantable cardioverter-defibrillator. Thus, in patients presenting with PIT but without a pacemaker indication, the pacemaker feature should be turned off, or, alternatively, the longest possible escape interval should be programmed.

Ventricular Tachyarrhythmias in Implantable Cardioverter Defibrillator Recipients: Differences Between Ischemic and Dilated Cardiomyopathies

“…Non sudden onset episodes required higher levels of shock energy and more frequent multiple shock achievements than sudden onset episodes [Gorenek et al 2006]. In the present study the analysis of the modes of VT-onset indicated that 12% of VT initiate immediately after a paced beat, which may suggest a proarrhythmic effect of pacing in some patients [Sweeney et al 2007, Himmrich et al 2003]. These results are consistent with recent findings: Sweeney et al [Sweeney et al 2007] found a 9.4% rate of VT initiated immediately after anti-bradycardia pacing in patients with a single chamber ICD, such as those used in our study.…”

The Effects of Catheter Ablation on Permanent Pacemakers and Implantable Cardiac Defibrillators

“…10 It is also important to consider that programming devices to address asynchronous pacing during catheter ablation can be associated with a low but possible risk of ventricular fibrillation/tachycardia, because of the pacing on the T-wave that occurs during the vulnerable ventricular period and/or short-long-short sequence. 11,12 Meanwhile, cryoablation has not been reported to cause interference with CIED pulse generator function. 13 Robotic ablation with remote magnetic catheter navigation (RMN) (Niobe s system, Stereotaxis, St. Louis, MO, USA) can be associated with EMI, since it uses magnetic fields to move an ablation catheter.…”

Cardiac Arrest Induced by Anti-Bradycardia and Anti-Tachycardia Therapies of an Implantable Cardioverter Defibrillator

“…The ICD is remarkably effective in preventing sudden cardiac death in high-risk patients [4], but it also has the capacity to provoke or worsen cardiac arrhythmias [1][2][3]. Tachyarrhythmias may result from the delivery of antitachycardia or anti-bradycardia therapies by tiered-therapy defibrillators.…”

“…Lots of studies demonstrated that ATP terminates most of VTs but with a 1% to 7% risk of acceleration or precipitation of these arrhythmias [1,2]. Also, anti-bradycardia therapy can have an intrinsic arrythmogenic risk [3].…”